My Patient Had Declined the COVID Vaccine … Every. Single. Time.

I currently work part-time at a local HIV clinic in Atlanta. Our patient population is predominantly Black and uninsured, and sometimes ensuring their access to good care and antiretroviral treatment (ART) is more challenging than finding a politician who is 100% truthful.

Since I started working there in February, I have had many conversations with patients about COVID-19 and the vaccine. I would estimate that about half of my patients have received the vaccine, while the other half still have questions and want to “wait and see.”

Some are concerned about potential long-term side effects.

Some are concerned about how quickly it was approved.

Others just aren’t big fans of vaccines in general.

The reasons folks cite for not wanting to be vaccinated are as varied as the hues of our skin tones. As a clinician, I just try to listen, acknowledge concerns, and gently inform them of the science and how during a pandemic, vaccination is about looking out for everyone, not just yourself.

Sometimes my nudging works. More often it does not. But those rare instances where continued nudging is effective make it all worth it.

Months ago, a young 25-year-old patient I will call “Derek” came to see me at our clinic. He is Black and same-gender loving, just like me, and he had recently been diagnosed with HIV.

Derek was scared and confused, and I felt his pain. After all, given his age and mine, he could’ve been my nephew or son — and I wanted to look after him as if he was. Over subsequent visits, we talked about his boyfriend, disclosure of his status, starting medications, and inviting other members of his family and social circles to learn about his HIV diagnosis. It was hard for him. His boyfriend broke up with him not long after his diagnosis, and he feared how he would navigate the dating scene with a stigmatizing three letter acronym now assuming part of his identity. He chose the ART regimen he preferred, and I could feel his palpable joy over the phone when I informed him that his viral load was undetectable within a month.

I gave him advice to the best of my abilities.

I passed him tissues during our visits and listened as he mourned the loss of his boyfriend and former existence.

Each time, at the end of every visit, I would ask him:

“So, you wanna get that COVID-19 vaccine today?”

He would look at me, eyes squinting over his mask.

“Naw, I’m good doc.”

Sometimes our conversations would embrace discussions about Black history and honoring our ancestors, so I tried that angle once as we were walking out of the examination room.

“Maybe the ancestors want you to protect yourself with this vaccine,” I said.

He didn’t miss a beat with his response.

“The ancestors want me to wait and see — I just talked with them this morning.”

We both laughed, but I often left our conversations deflated and enwrapped in feelings of failure as a physician. While successful at helping him achieve viral suppression with his HIV, I couldn’t get him to embrace the benefits of the vaccine to protect him and his loved ones from a virus causing a horrific pandemic.

Then, one morning in clinic, the front desk notified me of a patient who wasn’t on my schedule wanting to speak to me in the waiting area. I came out of my office to see who it was. Turning the corner, I saw Derek sitting in a chair, ear buds in while watching a video on his phone. His grin shone through his mask when he saw me.

“Hey doc!” he exclaimed, rising from the chair.

“Hey youngin’,” I responded. “You got an appointment with me today?”

“Naw, I just changed my phone number and when I didn’t hear from you about my lab results like I usually do, I figured it was because you had my old number. I came here to pick up my meds and wanted to see how my labs looked.”

He was right. I was glad he came in.

“Lemme check on that for you,” I said, “come on in here.”

We entered an examining room, and I closed the door. I pulled up his labs on the computer and showed them to him:

• His T cell count was almost 700
• His viral load was still undetectable
• All his STI screening was negative

After some brief small talk, I encouraged him to “keep doing what you’re doing” as I closed out his chart and made my way to open the door.

“One more thing doc,” he said, grabbing my arm.

I turned back to him as he removed his mask and flashed a smile as broad as the ocean, every last tooth glistening as if polished by the gods.

I stared at him for a moment, confused. I didn’t get it.

He paused, smiling harder, but after a few moments couldn’t contain it any longer.

“I got vaccinated!” he blurted out.

“You did?” I asked, stumped at the myriad occasions I had tried to get him to take the shot before, but he had declined.

Every.

Single.

Time.

Being honest with myself, I have to admit that as a clinician, I get weary of the COVID-19 vaccination discussion. The effort it takes to educate while simultaneously combatting and dispelling the preponderance of social media misinformation is a daunting task, even for the most skilled physician. When it happens patient after patient, it can drain your soul.

As a result, with him and a few other patients, I just stopped asking.

“What changed your mind?” I inquired, anticipating what his answer would likely be:

• His mother guilted him to do it
• A new boyfriend said it was a deal-breaker
• His pastor brought him spiritual enlightenment on the issue
• A good friend applied some peer pressure
• He learned of someone he knew contracting the virus

My guesses were as wrong as his response was instantaneous.

“You did, doc! You did!”

My mouth dropped under my mask. He went on to explain that he didn’t have any after effects except a sore arm, and that he was feeling great. He even wondered out loud why he waited so long.

As we parted ways and I turned to face the busy clinic day ahead, it suddenly didn’t matter what was in store for me after that.

Derek coming in to tell me he was vaccinated had truly made my day.

Maybe the ancestors wanted it that way after all.

David Malebranche, MD, MPH, is a board-certified internal medicine physician, researcher, and sexual health/HIV prevention and treatment specialist.